The DOI matches its Crossref record; 49 of the 51 references it cites were found in a registry or an index; none of the 19 sources its claims cite is checked for support yet.
Primary Care Physicians’ Use of an Electronic Medical Record System: A Cognitive Task Analysis
Open accessAbstract
Objective To describe physicians' patterns of using an Electronic Medical Record (EMR) system; to reveal the underlying cognitive elements involved in EMR use, possible resulting errors, and influences on patient-doctor communication; to gain insight into the role of expertise in incorporating EMRs into clinical practice in general and communicative behavior in particular.Design Cognitive task analysis using semi-structured interviews and field observations.Participants Twenty-five primary care physicians from the northern district of the largest health maintenance organization (HMO) in Israel.Results The comprehensiveness, organization, and readability of data in the EMR system reduced physicians' need to recall information from memory and the difficulty of reading handwriting. Physicians perceived EMR use as reducing the cognitive load associated with clinical tasks. Automaticity of EMR use contributed to efficiency, but sometimes resulted in errors, such as the selection of incorrect medication or the input of data into the wrong patient's chart. EMR use interfered with patient-doctor communication. The main strategy for overcoming this problem involved separating EMR use from time spent communicating with patients. Computer mastery and enhanced physicians' communication skills also helped.Conclusions There is a fine balance between the benefits and risks of EMR use. Automaticity, especially in combination with interruptions, emerged as the main cognitive factor contributing to errors. EMR use had a negative influence on communication, a problem that can be partially addressed by improving the spatial organization of physicians' offices and by enhancing physicians' computer and communication skills.
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59 Own result · 11 Not checked yet · 11 Own interpretation · 2 Own method · 1 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“EMR use interfered with patient-doctor communication.”
- Also stated in: § EMRs and Patient-Doctor Communication · plain
“Of the study participants, 92% felt EMR use disturbed communication with their patients.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
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- Also stated in: § EMRs and Patient-Doctor Communication · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The main strategy for overcoming this problem involved separating EMR use from time spent communicating with patients.”
- Also stated in: § EMRs and Patient-Doctor Communication · plain
“The main strategy entailed separating EMR use from time spent communicating with patients (Fig. 1).”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
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- Also stated in: § EMRs and Patient-Doctor Communication · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Automaticity of EMR use contributed to efficiency, but sometimes resulted in errors, such as the selection of incorrect medication or the input of data into the wrong patient's chart.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Physicians perceived EMR use as reducing the cognitive load associated with clinical tasks.”
- Also stated in: § EMRs and Cognitive Load · plain
“Overall, study participants felt the EMR system reduced their cognitive loads.”
- Also stated in: § DISCUSSION · hedged
“findings from the present study suggest that EMR use reduced physicians' cognitive loads associated with more demanding clinical tasks.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
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- Also stated in: § EMRs and Cognitive Load · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“During our observations we did not detect well-defined patientvisit stages.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Patient-Doctor Communication
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Three study physicians who employed the patient-centered model reported that this spatial organization often facilitated comments from patients, corrections, and greater information exchange.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Patient-Doctor Communication
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Typical errors reported by most study participants (>60%) were typos, adding information to the wrong patient's chart, and unintentionally selecting an erroneous item (diagnosis or medication) from a scroll-down list located above or below the desired item (Table 2).”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Perceptions of Patient Safety
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In all the cases observed, study participants reviewed printed prescriptions before signing and handing them to their patients.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Perceptions of Patient Safety
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“On the negative side, EMR use provoked new types of medical errors.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Perceptions of Patient Safety
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Ensuring documentation comprehensiveness was another element of expertise the majority of study participants noted.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Elements of Expertise
plain- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 25
- Probably not a substantial claim. 18
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The comprehensiveness, organization, and readability of data in the EMR system reduced physicians' need to recall information from memory and the difficulty of reading handwriting.”
- Also stated in: § EMRs and Cognitive Load · plain
“These aspects minimized the need to recall information from memory and eliminated the difficulty of reading handwriting.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
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- Also stated in: § EMRs and Cognitive Load · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Computer mastery and enhanced physicians' communication skills also helped.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Computer skills, especially blind typing and the use of keyboard shortcuts and templates, reduced the burden of typing and, therefore, allowed more time for communication (Table 2).”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Patient-Doctor Communication
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In several instances, study participants opened second charts as a result of interruptions; however, they always closed those charts before returning to their visiting patients.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Perceptions of Patient Safety
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Seventeen study participants reported the same encounter stages, although the sequence of events sometimes varied among physicians.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Patient-Doctor Communication
plainn = 17- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Typing in a patient's name opened a list of patients, and physicians sometimes accidentally selected the incorrect individual.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Perceptions of Patient Safety
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Elements of expertise appeared to be individual rather than related to physician accreditation, formal educational stage, or years of experience.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Elements of Expertise
hedged- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“They also said that the system's decisionmaking aids improved the quality of patient care.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Perceptions of Patient Safety
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“They usually achieved this element by typing data into their EMR systems; however, two study participants reported preparing comprehensive templates for common problems or examinations and using them as checklists to ensure anamnesis completeness.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Elements of Expertise
plainn = 2- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“both patients and EMR systems require physicians' focused attention”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“They were satisfied with the EMR system, especially with its data-related comprehensiveness, organization, and readability.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Cognitive Load
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“EMR use exerted both positive and negative impacts on patient safety.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Perceptions of Patient Safety
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The most influential skills observed were reading aloud while typing, maintaining eye contact, using body language to show attention and empathy, using humor to reduce tension, and leaving the computer completely and turning to the patient when conveying important information or discussing sensitive issues.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Patient-Doctor Communication
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“one participant commented that the automaticity associated with shortcuts and templates could induce errors”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
hedgeddirectSingle case- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“With one exception, physicians maintained eye contact with their patients and turned away from the computers.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > EMRs and Patient-Doctor Communication
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“the fact that more experienced users may be prone to EMR-related errors”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > IMPLICATIONS
hedgedconditional- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Other strategies and enabling factors were spatial organization of the office, blind typing, computer navigation, and communication skills”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Because they require little guidance or monitoring, automatic actions are fast and efficient.27 However, when actions that require attention become habitual, automaticity can lead to errors.[28][29][30]”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Automaticity
What the sources say
- Not checked yetcites [27] Wheatley T, Wegner DM. Automaticity of action, psychology of. In: Smelser NJ, Baltes PB, eds. International Encyclopedia of the Social & Behavioral Sciences. Oxford: Pergamon; 2001:991–993. source
- Not checked yetcites [28] Toft B, Mascie-Taylor H. Involuntary automaticity: a work-system induced risk to safe health care. Health Serv Manage Res. 2005;18(4):211–216. source
- Not checked yetcites [29] Green M. Error and injury in computers & medical devices. 2004. Available at: http://www.expertlaw.com/library/computers/computer_negligence.html . Accessed: Sep 18, 2008.
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Data collection continued until theoretical saturation 35 was reached.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Setting, Population, and Sample
What the sources say
- Not checked yetcites [35] Strauss AL, Corbin JM. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Newbury Park (CA): Sage; 1990.
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“This conclusion is consistent with the majority of previous studies, which report that EMRs have a positive impact on information exchange but that they often negatively affect patient-centeredness”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
plaindirect- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Analysis began as soon as data were accumulated, and the results of initial data analysis shaped further data collection and analysis”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Data Analysis
plaindirect- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This beneficial result arose as a result of data availability, readability, and organization, as well as, to some extent, decision support.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“The literature is replete with descriptions of automaticity-related errors as well as observations on the potential role of interruptions in causing medical errors.29,30,41,42”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
What the sources say
- Not checked yetcites [29] Green M. Error and injury in computers & medical devices. 2004. Available at: http://www.expertlaw.com/library/computers/computer_negligence.html . Accessed: Sep 18, 2008.
- Not checked yetcites [30] Green M. Nursing error. 2004. Available at: http://www.visualexpert.com/Resources/nursingerror.html Accessed: September 18, 2008.
- Not checked yetcites [41] Collins S, Currie L, Patel V, Bakken S, Cimino JJ. Multitasking by clinicians in the context of CPOE and CIS use. Medinfo. 2007;12(Pt 2):958–962.
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“EMR use had a negative influence on communication, a problem that can be partially addressed by improving the spatial organization of physicians' offices and by enhancing physicians' computer and communication skills.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Some previous research has suggested that patient-doctor communication in EMR settings varies depending on physician style, experience, and baseline communication skills.18,20,21,45”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
What the sources say
- Not checked yetcites [18] Booth N, Robinson P, Kohannejad J. Identification of high-quality consultation practice in primary care: the effects of computer use on doctor–patient rapport. Inform Prim Care. 2004;12(2):75–83. source
- Not checked yetcites [20] Ventres W, Kooienga S, Marlin R, Vuckovic N, Stewart V. Clinician style and examination room computers: a video ethnography. Fam Med. 2005;37(4):276–281.
- Not checked yetcites [21] Rouf E, Whittle J, Lu N, Schwartz MD. Computers in the exam room: differences in physician–patient interaction may be due to physician experience. J Gen Intern Med. 2007;22(1):43–48. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Similar concerns have been expressed in a recent viewpoint article 37”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
What the sources say
- Not checked yetcites [37] Simborg DW. Promoting electronic health record adoption. Is it the correct focus? J Am Med Inform Assoc. 2008;15(2):127–129. source
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The difference between our findings and those of other studies of computerized medical information systems may therefore be due to the long period of EMR use at Clalit and users' generally high level of expertise.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Initial agreement between researchers was high (83% on themes), and open discussions were held until consensus was reached.”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Data Analysis
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Previous studies have noted that CPOE and EMR systems do not fully support many tasks, thus increasing cognitive load and requiring users to adapt their information management strategies to the new technology.39,40”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
What the sources say
- Not checked yetcites [39] Weir CR, Nebeker JJ, Hicken BL, Campo R, Drews F, Lebar B. A cognitive task analysis of information management strategies in a computerized provider order entry environment. J Am Med Inform Assoc. 2007;14(1):65–75. source
- Not checked yetcites [40] Borycki EM, Lemieux-Charles L. Does a hybrid electronic-paper environment impact on health professional information seeking? Stud Health Technol Inform. 2008;136:505–510.
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
In the paper
“reflected in a study that found a steep rate of high risk copying and pasting of examination data.43”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
What the sources say
- Not checked yetcites [43] Thielke S, Hammond K, Helbig S. Copying and pasting of examinations within the electronic medical record. Int J Med Inform. 2007;76 Suppl 1:122–128. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Many of the challenges, best practices, and elements of expertise identified would provide physicians with a broad set of tools and strategies that may be employed flexibly during consultation”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > IMPLICATIONS
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The present study suggests it is important to go beyond these technical aspects of using EMR systems to a broader view of the benefits, risks, and principles of highquality use during patient visits”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > IMPLICATIONS
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Rests on an assumption: Few requirements exist for high usability standards.
- Rests on an assumption: Currently, EMR implementation and training tend to emphasize technical features like system functionality and capabilities.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Some of the problems uncovered in this study may be system-specific.Others are common to many computerized medical information systems and devices”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > IMPLICATIONS
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“These findings, too, are consistent with the literature.16,17,[44][45][46]”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > DISCUSSION
What the sources say
- Not checked yetcites [16] Makoul G, Curry RH, Tang PC. The use of electronic medical records: communication patterns in outpatient encounters. J Am Med Inform Assoc. 2001;8(6):610–615. source
- Not checked yetcites [17] Ventres W, Kooienga S, Vuckovic N, Marlin R, Nygren P, Stewart V. Physicians, Patients, and the electronic health record: an ethnographic analysis. Ann Fam Med. 2006;4(2):124–131. source
- Not checked yetcites [44] Frankel R, Altschuler A, George S, Kinsman J, Jimison H, Robertson NR, et al. Effects of exam-room computing on clinician–patient communication: a longitudinal qualitative study. J Gen Intern Med. 2005;20(8):677–682. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Computerized systems are often evaluated and sometimes certified for functionality and interoperability.47”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > IMPLICATIONS
What the sources say
- Not checked yetcites [47] Classen DC, Avery AJ, Bates DW. Evaluation and certification of computerized provider order entry systems. J Am Med Inform Assoc. 2007;14(1):48–55. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper relies on this without support.
In Israel, physicians must provide patients with printed prescriptions by hand, even when the prescription is generated electronically.
“in Israel, paper prescriptions are mandatory even when generated by an EMR system”
“Israeli law requires primary care physicians to print and physically hand prescriptions to their patients.”
The paper relies on this without support.
Few requirements exist for high usability standards.
“Generally, however, there are few requirements for high usability standards”
The paper relies on this without support.
Currently, EMR implementation and training tend to emphasize technical features like system functionality and capabilities.
“To date, EMR implementation and training usually focus on technological aspects, such as the functionality and capabilities of systems”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Clinical documentation is found to be associated with clinician burnout,1 increased cognitive load,2 information loss,3 and distractions.4”
From Challenges of developing a digital scribe to reduce clinical documentation burden (2019) · cites this paper as [3]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Data Collection
“using an interview protocol adapted from Millitelo and Hutton 33 (Appendix B).”
§ Primary Care Physicians' Use of an Electronic Medical Record System: A Cognitive Task Analysis > Additional information
“Adapted from Militello and Hutton 32 .”
Citations
Cites
Basics of Qualitative Research: Grounded Theory Procedures and Techniques.
Ellis, C., Strauss, A., & Corbin, J. M. (1992) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2074814 · Cited by 29,296
Basics of Qualitative Research: Grounded Theory Procedures and Techniques
Long, D. R., Strauss, A., & Corbin, J. M. (1993) · Modern Language Journal · doi:10.2307/328955 · Cited by 17,625
Cognitive Load During Problem Solving: Effects on Learning
Sweller, J. (1988) · Cognitive Science · doi:10.1016/0364-0213(88)90023-7 · Cited by 11,048
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Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W., Roth, E., Morton, S. C., & Shekelle, P. G. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-10-200605160-00125 · Cited by 3,159
Defining and Assessing Professional Competence
Epstein, R. M. (2002) · JAMA · doi:10.1001/jama.287.2.226 · Cited by 3,114
Cognitive Load Theory and the Format of Instruction
Chandler, P., & Sweller, J. (1991) · Cognition and Instruction · doi:10.1207/s1532690xci0804_2 · Cited by 2,894
A Five-Stage Model of the Mental Activities Involved in Directed Skill Acquisition
Dreyfus, S. E., & Dreyfus, H. L. (1980) · doi:10.21236/ada084551 · Cited by 1,572
Improving Safety with Information Technology
Bates, D. W., & Gawande, A. A. (2003) · New England Journal of Medicine · doi:10.1056/nejmsa020847 · Cited by 1,544
Han, Y. Y., Carcillo, J. A., Venkataraman, S. T., Clark, R. S. B., Watson, R. S., Nguyen, T. C., Bayir, H., & Orr, R. A. (2005) · Pediatrics · doi:10.1542/peds.2005-1287 · Cited by 1,149
Cited by
Sorted by citations
Boonstra, A., & Broekhuis, M. (2010) · BMC Health Services Research · doi:10.1186/1472-6963-10-231 · Cited by 851
Nguyen, L., Bellucci, E., & Nguyen, L. T. (2014) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2014.06.011 · Cited by 549
Electronic health record acceptance by physicians: Testing an integrated theoretical model
Gagnon, M., Ghandour, E. K., Talla, P. K., Simonyan, D., Godin, G., Labrecque, M., Ouimet, M., & Rousseau, M. (2013) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2013.10.010 · Cited by 250
Zahabi, M., Kaber, D. B., & Swangnetr, M. (2015) · Human Factors: The Journal of the Human Factors and Ergonomics Society · doi:10.1177/0018720815576827 · Cited by 240
Alkureishi, M. A., Lee, W. W., Lyons, M., Press, V. G., Imam, S., Nkansah-Amankra, A., Werner, D. A., & Arora, V. M. (2016) · Journal of General Internal Medicine · doi:10.1007/s11606-015-3582-1 · Cited by 254
Metadata
- Authors
- Shachak, A., Hadas-Dayagi, M., Ziv, A., & Reis, S.
- Affiliations
- Technion – Israel Institute of Technology (IL)
- Sheba Medical Center (IL)
- Corresponding author
- Shachak, Aviv
- Venue
- Journal of General Internal Medicine
- Published
- 2009-01-07
- Volume
- 24
- Issue
- 3
- Pages
- 341-348
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2642564
- OpenAlex
- W2007554419
- Semantic Scholar
- 14dcf4e304be438d4ad6d101d2ae977e0d1f53b4
- Cited by
- 188
- References
- 51
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 10 · 2021: 9 · 2020: 8 · 2019: 14 · 2018: 20 · 2017: 11 · 2016: 19 · 2015: 13 · 2014: 16 · 2013: 18 · 2012: 4
- FWCI
- 21.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Technology and Human Factors in Education and Health
- Keywords
- electronic health records, primary care physicians, cognitive task analysis, cognitive load, patient-doctor communication, medical errors, automaticity, interruptions, computer skills, physician expertise, health maintenance organizations
- MeSH terms
- Attitude to Computers, Female, Health Maintenance Organizations, Humans, Interviews as Topic, Israel, Male, Physician-Patient Relations, Physicians, Family, Professional Competence, Task Performance and Analysis, Cohort Studies, Medical Records Systems, Computerized
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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